Cushing face

Question 1

Causes of Cushings face

Answer 1

1. Long term steroid treatment
   • Renal - Nephrotic syndrome, various glomerulopathy
   • Skin - Eczema
   • Chest - Asthma
   • Autoimmune disease eg SLE
   • Blood - ITP, Leukaemia, Aplastic anaemia, Autoimmune hamolysis
2. Adrenal tumour - Carcinoma - with more virilising effect
3. Pituitary basophilic adenoma
4. Ectopic ACTH production - more aldosterone effect

Question 2

Steps for examination for Cushing Face

Answer 2

1. Cushing face - Moon face, facial plethora, thin skin, hirsute, acne

2. Look for other features of cushing syndrome
• Truncal obesity
• Thin limbs
• Buffalo hump
• Striae at abdomen and thigh

3. General examination 
• Height measurement 
• Note facial puffiness
• Eye - cataract
• Skin - Eczema, bleeding tendency

4. Chest - deformity
5. Abdomen - mass
6. Test for proximal muscle weakness
7. Test for bone pain and look for collapse and fracture of spine
8. Test visual fielde
9. Measure BP
   • Do urinalysis - sugar, protein, red cell

• • Cushingnoid + Pallor + Jaundice - Autoimmune Haemolysis
• • Cushingnoid + Hemiplegia =

1. Thrombosis
2. Hypertensive CVA
3. SLE
4. Meningitis